| NPI | 1851575948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC2200X Psychologist Clinical Child & Adolescent (Licence: CA 18755) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: CA 18755) |
| 103TF0000X Psychologist Family (Licence: CA 18755) | |
| Enumeration Date | 2007-12-25 |
| Last Update Date | 2007-12-25 |